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Knee Disorders Guideline

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Knee Disorders Guideline Knee Disorders Effective Date: December 3, 2019 Contributors Editor-in-Chief: Kurt T. Hegmann, MD, MPH, FACOEM, FACP Assistant Editors: Jeremy J. Biggs, MD, MSPH Matthew A. Hughes, MD, MPH Evidence-based Practice Knee Panel Chair: Ethan Lichtblau, MD, FRCS(C) Evidence-based Practice Knee Panel Members: David B. Coward, MD Clark D. Iorio, DO David S. Logerstedt, PT, PhD, MPT, MA, SCS Frederic G. Nicola, MD Kaochoy Saechao, MD, MPH June T. Spector, MD, MPH Methodology Committee Consultant: Patricia L. Sinnott, PT, PhD, MPH (2011) Kurt T. Hegmann, MD, MPH, FACOEM, FACP (2015) Managing Editors: Production: Marianne Dreger, MA Research: Julie A. Ording, MPH Editorial Assistant: Debra M. Paddack Research Conducted By: Kurt T. Hegmann, MD, MPH, FACOEM, FACP Kristine Hegmann, MSPH, CIC Matthew S. Thiese, PhD, MSPH Emilee Eden, BS, MPH Jenna L. Praggastis, BS Michael L. Northrup, BS Copyright 2019 Reed Group, Ltd. 1 Skyler D. Walker, BS Chapman B. Cox Melissa Gonzalez Weijun Yu, BM, BA, MS Helena Tremblay Amrinder K. Thind Uchenna Ogbonnaya, MS Jenny Dang, BS Patrick Bittenbender Specialty Society and Society Representative Listing: ACOEM acknowledges the following organizations and their representatives who served as reviewers of the “Knee Disorders” Guideline. Their contributions are greatly appreciated. By listing the following individuals or organizations, it does not infer that these individuals or organizations support or endorse the knee treatment guidelines developed by ACOEM. American Physical Therapy Association Gail D. Deyle, DPT, DSc Glenn N. Williams, PhD, PT, ATC Sara R. Piva, PT, PhD, OCS, FAAOMPT Copyright 2019 Reed Group, Ltd. 2 Table of Contents Summary of Recommendations .................................................................................................. 4 Overview ................................................................................................................................... 19 Basic Principles and Definitions ................................................................................................ 23 Initial Assessment ...................................................................................................................... 26 Medical History ......................................................................................................................... 28 Physical Examination ................................................................................................................. 31 Work-Relatedness ..................................................................................................................... 34 Diagnostic Criteria ..................................................................................................................... 37 Follow-up Visits ......................................................................................................................... 40 Diagnostic Recommendations................................................................................................... 41 Management Overview ............................................................................................................. 49 Treatment Recommendations .................................................................................................. 50 Knee Pain and Osteoarthrosis .............................................................................................. 50 Hamstring and Hip Flexor Strains ....................................................................................... 125 Iliotibial Band Syndrome ..................................................................................................... 125 Quadriceps, Gastrocnemius, and Soleus Strains ................................................................ 128 Knee Sprains (incl. Medial/Lateral Collateral Ligaments, Anterior/Posterior Cruciate Ligaments) ................................................................................................................................... 131 Anterior and Posterior Cruciate Ligament Tears ................................................................ 134 Meniscal Tears .................................................................................................................... 143 Knee Bursitis ....................................................................................................................... 151 Patellar Tendinosis, Patellar Tendinopathy (“Jumper’s Knee”), and Anterior Knee Pain .. 155 Appendix 1: Low-quality Randomized Controlled Trials and Non-randomized Studies ........ 165 References .............................................................................................................................. 166 Copyright 2019 Reed Group, Ltd. 3 Summary of Recommendations The Evidence-based Practice Knee Disorders Panel’s recommendations are based on critically appraised higher quality research evidence and on expert consensus observing First Principles when higher quality evidence was unavailable or inconsistent (see Methodology). The reader is cautioned to utilize the more detailed indications, specific appropriate diagnoses, temporal sequencing, preceding testing or conservative treatment, and contraindications that are elaborated in more detail for each test or treatment in the body of this Guideline in using these recommendations in clinical practice or medical management. These recommendations are not simple “yes/no” criteria. All ACOEM guidelines include analyses of numerous interventions, whether or not FDA-approved. For non- FDA-approved interventions, recommendations are based on the available evidence; however, this is not an endorsement of their use. In addition, many of the medications recommended are utilized off-label. (For example, anti-epileptic agents have been used off-label since the 1960s to treat chronic pain.) Recommendations are made under the following categories: • Strongly Recommended, “A” Level • Moderately Recommended, “B” Level • Recommended, “C” Level • Insufficient-Recommended (Consensus-based), “I” Level • Insufficient-No Recommendation (Consensus-based), “I” Level • Insufficient-Not Recommended (Consensus-based), “I” Level • Not Recommended, “C” Level • Moderately Not Recommended, “B” Level • Strongly Not Recommended, “A” Level Acetaminophen Acetaminophen for Treatment of Acute, Recommended, Evidence (C) Subacute, Chronic or Post-operative Knee Pain Acetaminophen or Aspirin as First-Line Strongly Recommended, Evidence (A) Therapy for Patients at Risk for Cardiovascular Adverse Effects Activity Activity Modification for Acute, Subacute, Recommended, Insufficient Evidence (I) Modification or Chronic Knee Pain Modifying Activities to Avoid Kneeling or Recommended, Insufficient Evidence (I) Other Pressure Over the Knee for Bursitis Acupuncture Acupuncture for Acute or Subacute Knee No Recommendation, Insufficient Evidence (I) Pain Acupuncture for Anterior Knee Pain No Recommendation, Insufficient Evidence (I) Acupuncture for Chronic Osteoarthrosis of Moderately Recommended, Evidence (B) the Knee Antibodies Antibodies for Diagnosing Knee Pain with Recommended, Insufficient Evidence (I) Suspicion of Chronic or Recurrent Rheumatological Disorder Antibodies to Confirm Specific Disorders Strongly Recommended, Evidence (A) Antibiotics One-day Use of Systemic Antibiotics for Moderately Recommended, Evidence (B) Knee Surgery Anticonvulsants Topiramate for Acute Knee Pain Not Recommended, Insufficient Evidence (I) Copyright 2019 Reed Group, Ltd. 4 Topiramate for Subacute or Chronic Knee No Recommendation, Insufficient Evidence (I) Pain Topiramate for Knee Osteoarthrosis No Recommendation, Insufficient Evidence (I) Antidepressants Norepinephrine Reuptake Inhibiting Anti- Not Recommended, Insufficient Evidence (I) depressants for Acute Knee Pain Norepinephrine Reuptake Inhibiting Anti- No Recommendation, Insufficient Evidence (I) depressants for Knee Osteoarthrosis Norepinephrine Reuptake Inhibiting Anti- No Recommendation, Insufficient Evidence (I) depressants for Subacute or Chronic Knee Pain Selective Serotonin Reuptake Inhibitors Not Recommended, Insufficient Evidence (I) for Acute, Subacute, or Chronic Knee Pain Selective Serotonin Reuptake Inhibitors, Recommended, Evidence (C) SSRIs, or Tricyclic Anti-depressants for Chronic Knee Pain in Patients with Co- morbid Depression Aspiration Aspiration for Infected Bursa Recommended, Insufficient Evidence (I) Fluid Aspiration and Analyses for Knee Recommended, Insufficient Evidence (I) Bursitis Aspirin Aspirin for Prevention of Venous Moderately Recommended, Evidence (B) Thromboembolic Disease Biofeedback Biofeedback for Chronic Knee Pain No Recommendation, Insufficient Evidence (I) Biofeedback for Patellofemoral Pain Not Recommended, Evidence (C) Bone Scans Bone Scanning for Select Use in Acute, Recommended, Insufficient Evidence (I) Subacute, or Chronic Knee Pain Routine Use of Bone Scanning for Knee Not Recommended, Insufficient Evidence (I) Joint Evaluations Braces Functional Bracing for Anterior Cruciate Not Recommended, Evidence (C) Ligament Injuries Post-operatively Functional Bracing for Prevention of No Recommendation, Insufficient Evidence (I) Anterior Knee Pain Functional Bracing for Treatment of Non- No Recommendation, Insufficient Evidence (I) Operative Anterior Cruciate Ligament Injuries Knee Braces for All Other Osteoarthrosis No Recommendation, Insufficient Evidence (I) Knee Braces for Knee Sprains Recommended, Insufficient Evidence (I) Knee Braces for Moderate to Severe
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